...AN INDEPENDENT VOICE FOR NURSING Work Engagement, Moral Distress, Education Level, and Critical Reflective Practice in Intensive Care Nurses nuf_237 256..268 Lisa A. Lawrence, PhD, RN Lisa A. Lawrence, PhD, RN, Instructional Faculty, Nursing Department, Pima Community College, Tucson, AZ Keywords Critical reflective practice, education level, moral distress, registered nurse, work engagement Correspondence Lisa A. Lawrence, PhD, RN, Nursing Department, Pima Community College, Tucson, AZ E-mail: llawrence@pima.edu AIM. The purpose of this study was to examine how nurses’ moral distress, education level, and critical reflective practice (CRP) related to their work engagement. The study is relevant to nursing, given registered nurse (RN) documented experiences of job-related distress and work dissatisfaction, and the nursing shortage crisis. A better understanding of factors that may enhance RN work engagement is needed. METHODS. A non-experimental, descriptive, correlational design was used to examine the relationships among four variables: moral distress, education level, CRP, and work engagement. The sample included 28 intensive care unit RNs from three separate ICUs in a 355-bed Southwest magnet-designated hospital. RESULTS. There was a positive direct relationship between CRP and work engagement, a negative direct relationship between moral distress and work engagement, and CRP and moral distress, together, explained 47% of the variance in work engagement. Additionally...
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...Advanced Leadership Skills I grew up in a conservative family. My father has served in the Philippine military and the Philippine government most of his life, and my mother was a dedicated nurse midwife and professor at a university hospital. Serving and caring for people has become second nature to my family. My father was strict and a disciplinarian; he did not allow my family to be out of the house after 6:00 p.m. He believed that it was important to have every member of the family home for dinner. It was from him that I learned the value of self-discipline, respect, and the importance of good education. Meanwhile, my mother was the go-to person for most of our relatives and family friends. Our home was open to anyone who was in need. It was from her that I learned to be available to the people I cared about. When asked about my leadership values, I always knew that they are strong reflections of my parents’ beliefs and practices. Self-reflection is essential in knowing who I am. My Advanced Leadership course from New York University has taught me that a leader is not born to have a specific characteristic or trait to be great; likewise, a unique leader has leadership gifts within him or her. To use this leadership gift to inspire and motivate others, George, Sims, McLean, and Mayer (2007) stated that I must come to understand who I am and my life stories and experiences in order to develop self-awareness. I must continue to explore and develop my values and principles...
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...Grand Canyon University 12/6/2013 There are new opportunities and programs for nurses as a result of the Affordable Care Act of 2010, which aims to increase quality, access and value of care. For this to come to fruition, the nursing scope of practice will be utilized to the fullest capacity, nursing education will include expanded skills and leadership roles will be increased from clinical setting to board rooms. With every decade, nursing has become an increasingly integral part of health care services, so that a future without large number of nurses is impossible to envision. (Institute of Medicine [IOM], 2010, p. 87). Transforming Nursing Practice Nursing practice will have to change from outdated scope of practice policies and procedures to updated ones that will allow for the creation of patient center systems. Health care is centering on more chronic conditions and less on acute and specialty settings. Long- term care and palliative care will be on an upward trend in the coming years due to the aging population. RNs will be better utilized as roles shift and expand to free up physicians from procedures such as IVs and cardiac outputs, health histories and performing exams. There will be increased RNs to patient ratio, which will result in less medication errors and lowered infection rates. On the other hand, given the projected nursing shortage, task shifting to overworked nurses could create unsafe patient care environments, especially in acute care hospitals...
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...Kyle Thompson – 05970640 Management of discharge Management skills in adult nursing UZTR6D4-40-2 05970640 The NMC Code (2008) charges nurses to protect confidential information, and to only use it for the purposes given – for their treatment. Therefore all patients and events mentioned in this essay are inspired by real patients and events, but names, locations, dates and other details have been altered or obscured to make identification impossible. Following the introduction of the knowledge and skills framework (DH 2004a) and emphasis on quality of health care and patient centred, interprofessional, health and social care (DH 2000; Leathard 2003; Thompson et al. 2002) health care professionals and students will need to be able to demonstrate the quality of our care and team working abilities. There is a connection between practice and thinking about practice – action and reflection are interdependent; they need one another. Reflection may be triggered by an awareness of a gap between theory and practice, a difference between what ‘should be’ and ‘what is’ (Sullivan & Decker 2005). Our actions and the quality of our care are improved by reflection-on-action, by making sense of what we have experienced, and thinking about how we might act differently in the future (Lillyman & Ghaye 2000). Reflection has a rôle in maintaining one's personal portfolio and maintaining competency and continuing professional development. Support and supervision from managers, who already have a responsibility...
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...(1988) Reflective cycle. This model is a recognised framework for my reflection. Gibbs (1988) consists of six stages to complete one cycle which is able to improve my teaching section continuously and learning from the experience for better practice in the future. The cycle starts with a description of the situation, next is to analysis of the feelings, third is an evaluation of the experience, fourth stage is an analysis to make sense of the experience, fifth stage is a conclusion of what else could I have done and final stage is an action plan to prepare if the situation arose again. (Source :Gibbs 1988) Gustaffsson and Fagerberg (2004) emphasizes on the advantages that could be gained from reflection mainly among registered nurses or RNs. They examine the questions on the implications of nurses’ reflections, the subject matter of their reflection and how they are able to deal with their reflection and how they improve their professional approach through reflection. The authors describe the experiences of the nurses and their reflection in relation to the nursing situations to understand how the nurses use reflection in their daily work. I am going to use the same approach to analyse my teaching section and improve where I have lacked to achieve required standards. Baird and Winter (2005) gave some rationale why reflection is required in the practice. They state that a reflect is to generate the practice knowledge, assist an ability to adapt new situations, develop self-esteem...
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...Introduction In line with the preparation of mentors, this assignment will aim to look at mentorship in depth. A variety of aspects around mentorship will be discussed, the first being the emergence of mentorship. This will explore what emphasis was placed on learning prior to Project 2000, and then moving to present day and the different documents that were implemented and the benefit these had on the mentoring process. Several definitions of mentorship will be addressed due to the lack of consensus regarding this. As a result, a clear distinction will be made between the differences of clinical supervision, perceptorship and the mentoring process. This will lead onto the role of the mentor, focusing upon relationships and the different theoretical perspectives around the formation of these. Also being explored in this section will be characteristics needed by the mentor as well as their responsibilities. The following topic to be explored will be learning styles and the environment. A definition of learning will be offered leading onto the learning environment and audits that are in place to ensure placements are up to scratch. This is followed by a description of learning models, looking at research that displays deficits with these. Also being looked at are the individual learning styles and characteristics. The final topic will be assessment; the author will offer a definition of assessment. This will lead onto formative and summative assessment, looking at the...
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...Reflection Paper One Advanced practice nursing (APN) can be loosely defined as an area of nursing in which nurses are required to practice at an advanced level in a specific area of interest. APN extends the boundaries of nursing’s scope of practice and contributes to nursing knowledge, and the development of the profession (Canadian Nurses Association, 2008). In order to become an APN, the nurse must obtain a master’s or doctoral degree from an accredited university in an area of concentration designated for advanced practice nursing. According to Joel (2009), there are currently four major groups of APNs: certified registered nurse anesthetist, certified nurse midwives, clinical nurse specialists, and nurse practitioners. APN focus on critical thinking, educating the public, diagnosing and treating illnesses, and prescribing medications to name a few. This paper will discuss the future of the nurse practitioner and how I, as a future adult-gerontology primary care nurse practitioner, will advocate for my patient population. Philosophy and Beliefs of Nurse Practitioners Due to the fact that nurse practitioner is a branch of advanced practice nursing, the two professions often share many of the same philosophic beliefs. The overall philosophy of both professions is centered on four key concepts of person, society, health and nursing; whereas, the core philosophy for nurse practitioners is that of individualized care where focus is on patients’ conditions, as well as, the...
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...School of Nursing Participates in professional organizations and activities that influence advanced practice nursing and/or health outcomes of a population focus. NONPF CORE COMPETENCY #2: Leadership NONPF Core Competency CATEGORY # II-7: Participates in professional organizations and activities that influence advanced practice nursing and/or health outcomes of a population focus DSGNE Program Outcome # 2: Utilize critical inquiry to advance the discipline and profession of nursing PYC Specialty Program Outcome # 2: Utilize an evidence-based approach to initiate change and improve primary care practice across the lifespan AACN Essential Standard # VI: Health Policy and Advocacy AACN Element # VI-5: Advocate for policies that improve the health of the public and the profession of nursing This Exhibit Contains: A membership certificate to the Coalition of Advanced Practice Nurses of Indiana (CAPNI). Rationale and Support: Joining professional organizations is a great way for advanced practice nurses to stay up to date on current healthcare information and share their ideas and opinions with other professionals. Professional organizations, such as CAPNI, provide numerous benefits for nurse practitioners. Becoming a member of a professional organization allows nurse practitioners to attend conferences and annual meeting with cohorts across the country. Attending these conferences is a great way to network with other professionals in the same field and...
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...when the American Nurses Association published a position paper that supported baccalaureate education as the entry level to practice (McCance & McKenna 1999). Previously, most nursing education took place in hospital schools (diploma programs), and the profession was very much under the control of medicine. Now, there's a lot to be said in favor of diploma programs, mostly the fact that diploma graduates usually have much more clinical experience, and are therefore more technically skilled than other entry-level graduates. However, the biggest disadvantage of these schools was that they did not teach nursing theory. Florence Nightengale was incorporated somewhat but the majority of the curricula were medically based. Nurses depended heavily on physiology, sociology, psychology, and medicine to provide academic standing and to inform practice (McEwan and Mills 2014). Some of the nursing classes were taught by the physicians, namely physiology and pathophysiology, and anatomy. Therefore, nurses were taught and trained to be the handmaidens of the physicians. In many circumstances, they were taught precisely what their doctors wanted, and how to anticipate and execute their doctors’ orders. They were also taught how to care for their doctors' patients. The regulatory and professional organizations in nursing education have required that critical thinking be essential to all nursing programs, but they have not satisfactorily distinguished critical reflection from ethical, clinical...
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...of positive health practices will become a societal norm” (Kreuter & Devore, 1980, p. 26). Despite the variances in definition health promotion is geared towards persuading public the benefits of a living a lifestyle free of negative health behaviors. The purpose of health promotion in nursing practice is to switch gears from protection of certain diseases to focus on improving the general health of the people they serve. Health promotion has changed the roles and responsibilities of nurses. Increasing demands are placed on nurses as healthcare has shifted from an acute, hospital-based care to preventive, community-based care. The home is now the primary place healthcare takes place. Reimbursement for hospital care is less resulting in shorter stays. Nurses must take on additional roles and play a bigger part of disease prevention and health promotion. A greater emphasis is being placed on nurses being more independent in their practice. Nurses are expected to be increasingly accountable morally and legally for their behavior. Nursing has evolved into many roles as advocates, care managers, consultants, delivery of services, educators, and healers. As advocates a nurses strives to ensure the patient receives the high quality, best care in a cost effective manner. In the role of a case manager the nurse strives to maintain continuity of care, prevent ineffective or unsafe care, and service duplication. To be successful in the role of care manager the nurse must...
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...Critically evaluate how the use of advanced communication skills may facilitate reflective practice and enhance the delivery of care in district nursing practice. Barbara Brush Student number: B00628470 Word count: 2084 Due Date: 3rd February 2015. Introduction. Due to the increasing demands on the Health Service the “Transforming your care “ report (Department of Health Social Service and Public Safety, (DHSSPS) 2011a) made recommendations to increase care in the community, making home the centre of care aiming to reduce the strain on limited resources and give value for money. Within the community care district nurses are vital, there role is autonomous, unique and varied. Furthermore there expert theory, skills, and knowledge of self and practice adds to their advanced interpersonal communication skills to assess clients with increasing complex needs (Blazor et al 2008). Communication is the cornerstone of the nurse patient therapeutic relationship and is the essence of good care (Stein-Parbury, 2009). Within the community care setting, therapeutic relationships are a high priority of the health service to enhance the well-being of the growing ageing population and patients with complex palliative care needs (Bain and Baguley 2012). The Department of Health (2006) acknowledges that communication is paramount for human interaction, otherwise people cannot relate to others effectively, make their needs known and identify what is happening to them. A fundamental aspect...
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...Ambiguity in Nursing Practice Kalli Stilos, RN, MScN, CHCPN(C), Shari L. Moura, RN, MN, CONC(C), CHCPN(C), and Frances Flint, RN, MN Current nursing literature recognizes the need to honor the concept of ambiguity. Nurses experience uncertainty with handling or honoring complexity and ambiguity when confronted with times of struggle. Traditional models of care fall short as patients and families define their expectations of the healthcare system. Nurses bear witness to the discomfort caused by the unknown in their daily practice. They are challenged to address their feelings, unsure of what to anticipate, what to say, or how to respond to their patients. Uncertainty diminishes the opportunity for meaningful dialogue between nurses and other people. Nurses attempting to ease the discomfort of ambiguity by providing patients or families with reassurance, offering advice on how to fix problems, or avoiding talking about situations often express dissatisfaction. Nurses should be invited to explore ambiguity and seek understanding through dialogue and nursing knowledge. Encouraging nurses to define the meaningfulness in nursing practice that embraces human science theory will help relieve some of the ambiguity that exists in current practice. This article will explore the concept of ambiguity, highlight how nursing theory based on human science can support practice, and propose recommendations for practice. urrent trends in the healthcare system call for nurses to build the capacity...
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...The aim of this assignment is to demonstrate that I can through critical reflection, evaluate my performance as a mentor to a student nurse I have been working with on the ward. According to the Nursing and Midwifery Council (NMC) (2006) the term mentor is used to denote the role of a registered nurse who facilitates learning and supervises and assesses students in the practice place. They furthermore identify the eight mandatory standards that must be achieved to become a mentor, and within the assignment I shall be referring to the Standards to Support Learning and Assessment in Practice; NMC standards for mentors, practice teachers and teachers, and identifying the standards for mentors required (SM). This assignment will first look at the personal and professional reasons why I wanted to undertake the mentorship module. It will also discuss the importance of a supportive learning environment in the workplace, and how essential it is. My role as a mentor to a nursing student will be evaluated, looking at the way in which I supported her on the ward and how I facilitated this. In conclusion, I will identify my own personal development in undertaking and completing this module. As a registered nurse on a busy Paediatric ward I always enjoy supporting student nurses whilst they are on placement with us. There is an apparent shortage of qualified mentors on the ward, and within my last personal development review with my line manager I identified a need to attain the mentorship...
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...My Reflection on Application of Analytic Methods Course Nursing profession of today’s world has called for the elevation of the advanced nursing education to a higher degree for a better patient health outcome (Cronenwett, et al., 2011). To this effect, in 2004 the American Association of Colleges of Nursing (ANCN) endorsed that the Advanced Practice Registered Nurses (APRN) receive training to the Doctor of Nursing Practice (DNP) degree. In reference to the APRN approval for a higher degree, I went back to school to earn a DNP degree. Looking back at my journey towards obtaining a DNP degree at Chamberlain College of Nursing, I will proudly say that I have completed a sixteen week of my DNP journey that the ANCN has advocated for. Hence, the following account is a self-reflection of my experience in the application of analytical methods course. Over that...
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...and Social Care www.brookes.ac.uk/schools/shsc mentoring a resource for those who facilitate placement learning Developed by The Practice Education Group (PEG) students and mentors School of Health & Social Care Oxford Brookes University Specific contributions by Pam Sharp, Tim Ainslie, Anna Hemphill, Stephanie Hobson Clair Merriman, Paul Ong, Judy Roche go to contents page > Definitions Placement learning “is a planned period of learning, normally outside the institution at which the student is enrolled, where the learning outcomes are an intended part of a programme of study. It includes those circumstances where students have arranged their own learning opportunity with a placement provider, with the approval of the institution…” (Quality Assurance Agency QAA (2001), Section 9 pg 4, Code of Practice for the assurance of academic quality standards in Higher Education Institutions) Accessed on 24.6.05 www.qaa.ac.uk/academicinfrastructure/codeOfPractice/section9/PlacementLearning.pdf Facilitation roles Those who facilitate placement learning undertake a variety of roles which may include support, assessment and facilitation of learning. There is a wide range of role titles that describe these roles including: Assessor, Mentor, Practice Educator, Preceptor, Clinical Teacher, Associate Mentor, Clinical Educator or Practice Teacher. 2 Version 1 September 2005 © School of Health and Social Care, Oxford Brookes University, Oxford Contents 'Mentoring'...
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